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Objective: To investigate the food shopping habits of older adults in the UK and explore their potential associations with selected health-related indicators., Design: A cross-sectional study including objectively measured physical activity levels, BMI, physical function and self-reported health status and dietary intake., Setting: Bristol, UK., Subjects: A total of 240 older adults aged ≥70 years living independently., Results: Mean age was 78·1 (sd 5·7) years; 66·7 % were overweight or obese and 4 % were underweight. Most (80·0 %) carried out their own food shopping; 53·3 % shopped at least once weekly. Women were more likely to shop alone (P < 0·001) and men more likely to shop with their spouse (P < 0·001). Men were more likely than women to drive to food shopping (P < 0·001), with women more likely to take the bus or be driven (P < 0·001). Most reported ease in purchasing fruit and vegetables (72·9 %) and low-fat products (67·5 %); 19·2 % reported low fibre intakes and 16·2 % reported high fat intakes. Higher levels of physical function and physical activity and better general health were significantly correlated with the ease of purchasing fresh fruit, vegetables and low-fat products. Shopping more often was associated with higher fat intake (P = 0·03); higher levels of deprivation were associated with lower fibre intake (P = 0·019)., Conclusions: These findings suggest a pattern of food shopping carried out primarily by car at least once weekly at large supermarket chains, with most finding high-quality fruit, vegetables and low-fat products easily accessible. Higher levels of physical function and physical activity and better self-reported health are important in supporting food shopping and maintaining independence.

Urticaria and angioedema are common disorders that can severely impair the quality of a patient's life and can be extremely difficult to treat. Symptoms can persist for years to decades. The causes of urticaria and angioedema are varied and may be immunologic, nonimmunologic, or idiopathic. This article reviews the literature and provides primary care physicians with up-to-date information of the epidemiology, basic pathophysiology, diagnosis, and management of this common and often debilitating condition. Additionally, clinical manifestations of acute and chronic urticaria, hereditary and acquired angioedema, as well as the physical urticarias will be discussed., (© 2011 Mount Sinai School of Medicine.)

Rapid electrical conduction in the His-Purkinje system tightly controls spatiotemporal activation of the ventricles. Although recent work has shed much light on the regulation of early specification and morphogenesis of the His-Purkinje system, less is known about how transcriptional regulation establishes impulse conduction properties of the constituent cells. Here we show that Iroquois homeobox gene 3 (Irx3) is critical for efficient conduction in this specialized tissue by antithetically regulating two gap junction-forming connexins (Cxs). Loss of Irx3 resulted in disruption of the rapid coordinated spread of ventricular excitation, reduced levels of Cx40, and ectopic Cx43 expression in the proximal bundle branches. Irx3 directly represses Cx43 transcription and indirectly activates Cx40 transcription. Our results reveal a critical role for Irx3 in the precise regulation of intercellular gap junction coupling and impulse propagation in the heart.

This paper examines discourse on serodiscordant relationships in interviews with 16 HIV-positive and 3 HIV-negative gay men living in Scotland. Drawing on critiques concerning love, reason and HIV serostatus normativity, this paper supplies a much-needed insight into how gay men in serodiscordant relationships negotiate HIV prevention. Among other matters, some HIV-negative men were said to knowingly request risky sex with their HIV-positive partners as an expression of love. In some situations, the person without HIV claimed a normative serostatus that implied they could 'invest' more in the relationship by offering to have sexual intercourse that may expose them to HIV. Such dynamics expressed devotion on the part of the HIV-negative man, but implied obligation for the HIV-positive man. Based on these and other perspectives we argue for closer attention to gay men's subjectivity in the present circumstances of proliferating biomedical forms of HIV prevention; more thoroughly reflexive public health engagements with gay men's sexual cultures; and a research agenda for gay men that challenges HIV-serostatus normativity.

Personality psychology has recognized a fundamental 5-factor structure that has integrated and organized theory and research. Nevertheless, personality-like differences beyond that structure have been identified. In heretofore unrelated research, dispositional empathy has been an essential construct in understanding human development, behavior, and interpersonal relationships. Addressing a gap in the literature, we map multidimensional dispositional empathy into 2 versions of the 5-factor space. Empathic concern is closely related to agreeableness, and personal distress is closely related to neuroticism. Perspective taking has complex, interstitial relationships with the 5 factors. In contrast, fantasy is not well explained by the 5 factors. We discuss the implications of these findings for understanding dispositional empathy and for understanding the 5-factor structure, its correlates in emotional processes and experiences, and its limits.

This article examines how pandemic influenza control policies interpellate the public. We analyse Australian pandemic control documents and key informant interviews, with reference to the H1N1 virus in 2009. Our analysis suggests that the episodic and uncertain features of pandemic influenza give control measures a pronounced tactical character. The general public is seen as passive and, in some cases, vulnerable to pandemic influenza. Communication focuses on promoting public compliance with prescribed guidelines, but without inspiring complacency, panic or other unruly responses. These assumptions depend, however, on a limited social imaginary of publics responding to pandemics. Drawing on Foucault, we consider how it is that these assumptions regarding the public responses to pandemics have taken their present form. We show that the virological modelling used in planning and health securitisation both separate pandemic control from its publics. Further, these approaches to planning rely on a restricted view of human agency and therefore preclude alternatives to compliance-complacency-panic and, as we suggest, compromise pandemic control. On this basis we argue that effective pandemic control requires a systematic dialogue with the publics it seeks to prepare in anticipation of the event of pandemic influenza., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Hereditary angioedema (HAE) caused by C1-esterase inhibitor deficiency is an autosomal-dominant disease resulting from a mutation in the C1-inhibitor gene. HAE is characterized by recurrent attacks of intense, massive, localized subcutaneous edema involving the extremities, genitalia, face, or trunk, or submucosal edema of upper airway or bowels. These symptoms may be disabling, have a dramatic impact on quality of life, and can be life-threatening when affecting the upper airways. Because the manifestations and severity of HAE are highly variable and unpredictable, patients need individualized care to reduce the burden of HAE on daily life. Although effective therapy for the treatment of HAE attacks has been available in many countries for more than 30 years, until recently, there were no agents approved in the United States to treat HAE acutely. Therefore, prophylactic therapy is an integral part of HAE treatment in the United States and for selected patients worldwide. Routine long-term prophylaxis with either attenuated androgens or C1-esterase inhibitor has been shown to reduce the frequency and severity of HAE attacks. Therapy with attenuated androgens, a mainstay of treatment in the past, has been marked by concern about potential adverse effects. C1-esterase inhibitor works directly on the complement and contact plasma cascades to reduce bradykinin release, which is the primary pathologic mechanism in HAE. Different approaches to long-term prophylactic therapy can be used to successfully manage HAE when tailored to meet the needs of the individual patient.

Induction of tolerance protocols have been applied successfully to manage allergic reactions to many medications. Hypersensitivity reactions to natalizumab (TYSABRI®) have been recognized as a growing problem. In circumstances where a hypersensitivity reaction to a medication has occurred, but no suitable alternative exists, drug induction of tolerance protocols may be considered. Drug induction of tolerance protocols were performed in three patients with prior hypersensitivity reactions to natalizumab. All three patients tolerated the protocol without adverse reactions, allowing for the safe reintroduction of natalizumab. To conclude, this case series demonstrates success with an induction of tolerance procedure to a highly effective biological agent for multiple sclerosis, in patients with allergic reactions to natalizumab.

The lignin content of biomass can impact the ease and cost of biomass processing. Lignin reduction through breeding and genetic modification therefore has potential to reduce costs in biomass-processing industries (e.g. pulp and paper, forage, and lignocellulosic ethanol). We investigated compositional changes in two low-lignin alfalfa (Medicago sativa) lines with antisense down-regulation of p-coumarate 3-hydroxylase (C3H) or hydroxycinnamoyl-CoA:shikimate hydroxycinnamoyltransferase (HCT). We investigated whether the difference in reactivity during lignification of 4-coumaryl alcohol (H) monomers versus the naturally dominant sinapyl alcohol and coniferyl alcohol lignin monomers alters the lignin structure. Sequential base extraction readily reduced the H monomer content of the transgenic lines, leaving a residual lignin greatly enriched in H subunits; the extraction profile highlighted the difference between the control and transgenic lines. Gel permeation chromatography of isolated ball-milled lignin indicated significant changes in the weight average molecular weight distribution of the control versus transgenic lines (CTR1a, 6000; C3H4a, 5500; C3H9a, 4000; and HCT30a, 4000).

In this study, we established a comprehensive genetic map with a large number of progeny from a three-generation hybrid Populus intercross, and phenotyped the lignin content, S/G ratio and 28 cell wall subcomponents both in stems and roots for the mapping individuals. Phenotypic analysis revealed that lignin content and syringyl-to-guaiacyl (S/G) ratio using pyrolysis molecular beam mass spectroscopy (pyMBMS) varied among mapping individuals. Phenotypic analysis revealed that stem lignin content is significantly higher than that in root and the quantified traits can be classified into four distinct groups, with strong correlations observed among components within organs. Altogether, 179 coordinating QTLs were detected, and they were co-localized into 49 genetic loci, 27 of which appear to be pleiotropic. Many of the detected genetic loci were detected differentially in stem and root. This is the first report of separate genetic loci controlling cell wall phenotypes above and below ground. These results suggest that it may be possible to modify lignin content and composition via breed and/or engineer as a means of simultaneously improving Populus for cellulosic ethanol production and carbon sequestration.

Complexities in sample handling, instrument setup and data analysis are barriers to the effective use of flow cytometry to monitor immunological parameters in clinical trials. The novel use of a central laboratory may help mitigate these issues.

Modern epidemiological studies face opportunities and challenges posed by an ever-expanding capacity to measure a wide range of environmental exposures, along with sophisticated biomarkers of exposure and response at the individual level. The challenge of deciding what to measure is further complicated for longitudinal studies, where logistical and cost constraints preclude the collection of all possible measurements on all participants at every follow-up time. This is true for the National Children's Study (NCS), a large-scale longitudinal study that will enroll women both prior to conception and during pregnancy and collect information on their environment, their pregnancies, and their children's development through early adulthood-with a goal of assessing key exposure/outcome relationships among a cohort of approximately 100 000 children. The success of the NCS will significantly depend on the accurate, yet cost-effective, characterization of environmental exposures thought to be related to the health outcomes of interest. The purpose of this paper is to explore the use of cost saving, yet valid and adequately powered statistical approaches for gathering exposure information within epidemiological cohort studies. The proposed approach involves the collection of detailed exposure assessment information on a specially selected subset of the study population, and collection of less-costly, and presumably less-detailed and less-burdensome, surrogate measures across the entire cohort. We show that large-scale efficiency in costs and burden may be achieved without making substantive sacrifices on the ability to draw reliable inferences concerning the relationship between exposure and health outcome. Several detailed scenarios are provided that document how the targeted sub-sampling design strategy can benefit large cohort studies like the NCS, as well as other more focused environmental epidemiologic studies., (Published in 2010 by John Wiley & Sons, Ltd.)

We report the first Australian families with inclusion-body myopathy, Paget's disease of the bone and frontotemporal dementia (IBMPFD). The clinical characteristics of the two pedigrees are described including a previously undescribed phenotypic feature of pyramidal tract dysfunction in one family member. A novel mutation in the valosin-containing protein (VCP) gene (p.Arg155Leu) was found in one family while the other family had a previously reported mutation (p.Leu198Trp). Our findings broaden the phenotypic spectrum of IBMPFD and further emphasise the resemblance to amyotrophic lateral sclerosis in some cases., (2010 Elsevier B.V. All rights reserved.)

This article describes a new automated method for the controlled occlusion of vision during natural tasks. The method permits the time course of the presence or absence of visual information to be linked to identifiable events within the task of interest. An example application is presented in which the method is used to examine the ability of cricket batsmen to pick up useful information from the prerelease movement patterns of the opposing bowler. Two key events, separated by a consistent within-action time lag, were identified in the cricket bowling action sequence-namely, the penultimate foot strike prior to ball release (Event 1), and the subsequent moment of ball release (Event 2). Force-plate registration of Event 1 was then used as a trigger to facilitate automated occlusion of vision using liquid crystal occlusion goggles at time points relative to Event 2. Validation demonstrated that, compared with existing approaches that are based on manual triggering, this method of occlusion permitted considerable gains in temporal precision and a reduction in the number of unusable trials. A more efficient and accurate protocol to examine anticipation is produced, while preserving the important natural coupling between perception and action.

Background: As a major component of plant cell wall, lignin plays important roles in mechanical support, water transport, and stress responses. As the main cause for the recalcitrance of plant cell wall, lignin modification has been a major task for bioenergy feedstock improvement. The study of the evolution and function of lignin biosynthesis genes thus has two-fold implications. First, the lignin biosynthesis pathway provides an excellent model to study the coordinative evolution of a biochemical pathway in plants. Second, understanding the function and evolution of lignin biosynthesis genes will guide us to develop better strategies for bioenergy feedstock improvement., Results: We analyzed lignin biosynthesis genes from fourteen plant species and one symbiotic fungal species. Comprehensive comparative genome analysis was carried out to study the distribution, relatedness, and family expansion of the lignin biosynthesis genes across the plant kingdom. In addition, we also analyzed the comparative synteny map between rice and sorghum to study the evolution of lignin biosynthesis genes within the Poaceae family and the chromosome evolution between the two species. Comprehensive lignin biosynthesis gene expression analysis was performed in rice, poplar and Arabidopsis. The representative data from rice indicates that different fates of gene duplications exist for lignin biosynthesis genes. In addition, we also carried out the biomass composition analysis of nine Arabidopsis mutants with both MBMS analysis and traditional wet chemistry methods. The results were analyzed together with the genomics analysis., Conclusion: The research revealed that, among the species analyzed, the complete lignin biosynthesis pathway first appeared in moss; the pathway is absent in green algae. The expansion of lignin biosynthesis gene families correlates with substrate diversity. In addition, we found that the expansion of the gene families mostly occurred after the divergence of monocots and dicots, with the exception of the C4H gene family. Gene expression analysis revealed different fates of gene duplications, largely confirming plants are tolerant to gene dosage effects. The rapid expansion of lignin biosynthesis genes indicated that the translation of transgenic lignin modification strategies from model species to bioenergy feedstock might only be successful between the closely relevant species within the same family.

Although ecological risk assessments (ERAs) and natural resource damage assessments (NRDAs) are performed under different statutory and regulatory authorities, primarily the Comprehensive Environmental Response, Compensation and Liability Act (CERCLA), as currently practiced, the activities typically overlap. ERAs performed as part of the response process (typically by the US Environmental Protection Agency [USEPA]) should be closely coordinated with the natural resource trustees' (trustees') NRDAs. Trustees should actively participate in the early stages of the remedial investigation (RI) and work with USEPA, including the potentially responsible parties (PRPs), when appropriate, to coordinate NRDA data needs with those of the RI. Close coordination can present opportunities to avoid inefficiencies, such as unnecessary resampling or duplicate data gathering, and provide the opportunity to fulfill both process requirements with a few well-designed investigations. Early identification of opportunities for practical combined assessment can save money and time as the restoration process proceeds and facilitate a cooperative resolution of the entire site's CERCLA liability. The Society of Environmental Toxicology and Chemistry (SETAC) convened an invited workshop (August 2008) to address coordination between ERA and NRDA efforts. This paper presents the findings and conclusions of the Framework Work Group, which considered technical issues common to each process, while mindful of the current legal and policy landscape, and developed recommendations for future practice.

Very few cultivated microorganisms can degrade lignocellulosic biomass without chemical pretreatment. We show here that "Anaerocellum thermophilum" DSM 6725, an anaerobic bacterium that grows optimally at 75 degrees C, efficiently utilizes various types of untreated plant biomass, as well as crystalline cellulose and xylan. These include hardwoods such as poplar, low-lignin grasses such as napier and Bermuda grasses, and high-lignin grasses such as switchgrass. The organism did not utilize only the soluble fraction of the untreated biomass, since insoluble plant biomass (as well as cellulose and xylan) obtained after washing at 75 degrees C for 18 h also served as a growth substrate. The predominant end products from all growth substrates were hydrogen, acetate, and lactate. Glucose and cellobiose (on crystalline cellulose) and xylose and xylobiose (on xylan) also accumulated in the growth media during growth on the defined substrates but not during growth on the plant biomass. A. thermophilum DSM 6725 grew well on first- and second-spent biomass derived from poplar and switchgrass, where spent biomass is defined as the insoluble growth substrate recovered after the organism has reached late stationary phase. No evidence was found for the direct attachment of A. thermophilum DSM 6725 to the plant biomass. This organism differs from the closely related strain A. thermophilum Z-1320 in its ability to grow on xylose and pectin. Caldicellulosiruptor saccharolyticus DSM 8903 (optimum growth temperature, 70 degrees C), a close relative of A. thermophilum DSM 6725, grew well on switchgrass but not on poplar, indicating a significant difference in the biomass-degrading abilities of these two otherwise very similar organisms.

The genetic control of carbon allocation and partitioning in woody perennial plants is poorly understood despite its importance for carbon sequestration, biofuels and other wood-based industries. It is also unclear how environmental cues, such as nitrogen availability, impact the genes that regulate growth, biomass allocation and wood composition in trees. We phenotyped 396 clonally replicated genotypes of an interspecific pseudo-backcross pedigree of Populus for wood composition and biomass traits in above- and below-ground organs. The loci that regulate growth, carbon allocation and partitioning under two nitrogen conditions were identified, defining the contribution of environmental cues to their genetic control. Sixty-three quantitative trait loci were identified for the 20 traits analyzed. The majority of quantitative trait loci are specific to one of the two nitrogen treatments, demonstrating significant nitrogen-dependent genetic control. A highly significant genetic correlation was observed between plant growth and lignin/cellulose composition, and quantitative trait loci co-localization identified the genomic position of potential pleiotropic regulators. Pleiotropic loci linking higher growth rates to wood with less lignin are excellent targets to engineer tree germplasm improved for pulp, paper and cellulosic ethanol production. The causative genes are being identified with a genetical genomics approach.

Nemaline myopathy is a heterogenous form of congenital myopathy characterised by a variable spectrum of clinical features, predominated in the severe form by profound muscle hypotonia and weakness accompanied by respiratory insufficiency. The clinical variability, with differing age of onset and severity of symptoms makes the diagnosis of nemaline myopathy difficult in some cases. Severe forms of nemaline myopathy may be caused by mutation of a number of different genes: skeletal muscle actin (ACTA1), nebulin (NEB) and alpha-tropomyosin (TPM3), all of which encode components of the sarcomeric thin filaments of skeletal muscle. We describe the severe form of nemaline myopathy diagnosed in two brothers who died at the age of 12 days and 9 months, due to respiratory insufficiency caused by severe muscle weakness. Polyhydramnios and weakness of foetal movements in the IIIrd trimester of pregnancy, as well as variable clinical severity were noted in both cases. Microscopically visible significant immaturity of muscle fibers was found in the skeletal muscle biopsy performed in one of the brothers. The diagnosis of nemaline myopathy was confirmed by the presence of nemaline bodies (rods) in sections stained using the Gomori trichrome method. Molecular studies of DNA isolated from blood leucocytes showed no mutation in the ACTA1 or the TPM3 genes. Linkage analysis with polymorphic markers did not rule out linkage to part of the NEB gene locus. Results of the clinical evaluation and the investigations performed in the family members confirm that it is essential to consider congenital myopathies in the differential diagnosis of neonatal and infantile hypotonia with respiratory insufficiency. Molecular verification of the clinical diagnosis is also important for genetic counselling of the families.

We describe a high-throughput method for estimating cell-wall chemistry traits using analytical pyrolysis. The instrument used to perform the high-throughput cell-wall chemistry analysis consists of a commercially available pyrolysis unit and autosampler coupled to a custom-built molecular beam mass spectrometer. The system is capable of analyzing approximately 42 biomass samples per hour. Lignin content and syringyl to guaiacol (S/G) ratios can be estimated directly from the spectra and differences in cell wall chemistry in large groups of samples can easily be identified using multivariate statistical data analysis methods. The utility of the system is demonstrated on a set of 800 greenhouse-grown poplar trees grown under two contrasting nitrogen treatments. High-throughput analytical pyrolysis was able to determine that the lignin content varied between 13 and 28% and the S/G ratio ranged from 0.5 to 1.5. There was more cell-wall chemistry variation in the plants grown under high nitrogen conditions than trees grown under nitrogen-deficiency conditions. Analytical pyrolysis allows the user to rapidly screen large numbers of samples at low cost, using very little sample material while producing reliable and reproducible results.

The goal of this investigation was to identify microlevel processes in the support provider that may foster or inhibit the provision of spousal support. Specifically, the authors focused on (a) how emotional similarity between the support provider and support seeker and (b) how empathic accuracy of the support provider relate to support provision in marriage. In a laboratory experiment, 30 couples were randomly assigned to 1 of 2 conditions (support provider: man vs. woman) of a factorial design. The couples provided questionnaire data and participated in a social support interaction designed to assess behaviors when offering and soliciting social support. A video-review task was used to assess emotional similarity and empathic accuracy during the support interaction. As expected, greater similarity between the support provider's and support seeker's emotional responses, as well as more accurate insights into the support-seeking spouse's thoughts and feelings were found to be predictive of more skilful support (i.e., higher levels of emotional and instrumental support and lower levels of negative types of support)., (2008 APA, all rights reserved)

The development of cable force during hammer-throw turns is crucial to the throw distance. In this paper, we present a method that is capable of measuring cable force in real time and, as it does not interfere with technique, it is capable of providing immediate feedback to coaches and athletes during training. A strain gauge was mounted on the wires of three hammers to measure the tension in the wire and an elite male hammer thrower executed three throws with each hammer. The output from the gauges was recorded by a data logger positioned on the lower back of the thrower. The throws were captured by three high-speed video cameras and the three-dimensional position of the hammer's head was determined by digitizing the images manually. The five best throws were analysed. The force acting on the hammer's head was calculated from Newton's second law of motion and this was compared with the force measured via the strain gauge. Qualitatively the time dependence of the two forces was essentially the same, although the measured force showed more detail in the troughs of the force-time curves. Quantitatively the average difference between the measured and calculated forces over the five throws was 76 N, which corresponds to a difference of 3.8% for a cable force of 2000 N.

Increases in reported unsafe sex among gay men have been explained as resistance to HIV prevention, or most recently, with the idea that a hyper-individualization of sexual action contributes to the loss of sexual community. This turning in HIV prevention has come to focus on the sexual action of gay men with HIV through the frames of: sexual transgression, sometimes called 'barebacking'; and altruism. Adopting the perspective of sexual citizenship in connection with qualitative interviews, this paper considers how gay men with HIV account for their sexual practice in light of the dual discourse of transgression/altruism. The paper will argue that gay men with HIV are deeply aware of what transgression/altruism implies for their identities and sexual relations, indicating the continued salience of community for sexual practice. Further, in the circumstances of blaming in relation to the moral labour of safer sex, gay men with HIV are trying to work out a co-operative practice for HIV prevention based on self-care, a moderated altruism and the voluntary action of sexual partners.

EMOTLAB software creates a virtual social environment in which individuals interact via computer with a virtual interaction partner in a series of economic bargaining games. The virtual partner appears on the participant's computer screen as a digital image (e.g., video or picture file) during each trial. A key feature of EMOTLAB software is its ability to control both the strategic behavior and the emotion signaling behavior (e.g., anger vs. embarrassment) of the virtual interaction partner. By simply editing a series of text files that control the subroutines governing the different features of the experiment (payoff structure, number of trials, etc.), EMOTLAB can generate an essentially infinite number of different social bargaining situations in which participants earn monetary payoffs contingent upon their decisions. This paper provides an overview of this software and how one can edit various subroutines to generate a typical experimental session in which research participants encounter a virtual interaction partner who displays different emotional signals.

The objective was to examine how many young men who have sex with men (MSM) meet their first sexual partner through the Internet and whether this has increased over time. In 2003, 2505 MSM surveyed on UK Internet sites completed a self-administered questionnaire. Data were analysed for 810 MSM who were under 30 years old at the time of the survey and who first had sex with another man between 1993-2002. During this period there was a significant increase in the percentage of MSM who met their first male sexual partner through the Internet (2.6-61.0%). There was a corresponding decrease in the percentage who met their first sexual partner at a gay venue (34.2-16.9%), school (23.7-1.3%), a public sex environment, through small ads or telephone chatlines (10.5-1.3%). An increasing number of young MSM appear to meet their first sexual partner through the Internet. Online sexual health interventions should be developed targeting men early in their sexual careers.

The majority of high-stakes tests from elementary school through postsecondary education include the timed impromptu essay as a measure of writing performance. For adolescents with writing disorders, this type of evaluation often presents a significant barrier. The purpose of the current study was twofold. First, we investigated the influence of handwritten, typed, and typed/edited formats of an expository essay on the quality scores received by students with (n = 65) and without (n = 65) dyslexia. Second, we examined the contribution of spelling, handwriting, fluency, and vocabulary complexity to the quality scores that students with and without dyslexia received on the same writing task. Analyses indicated that vocabulary complexity, verbosity, spelling, and handwriting accounted for more variance in essay quality scores for writers with dyslexia than for their typically achieving peers. Both group and individual student outcomes are reported to better understand the needs of struggling writers with dyslexia. Implications for assessment, instruction, and accommodations are discussed with an eye toward reform efforts that target improved teaching and learning.

Background: Hemoglobin and amino-terminal pro-brain natriuretic peptide (NT-proBNP) are both independent predictors of mortality in patients with chronic HF. Their combined predictive power for mortality in the setting of acute HF is uncertain., Methods: In an international prospective cohort design, we evaluated the relationships between hemoglobin, NT-proBNP, and 60-day mortality in 690 patients with acute HF., Results: The median hemoglobin for the entire cohort was 13.0 g/dL (interquartile range 11.6-14.3). The WHO criterion for anemia was met by 44% (n=305). The 60-day mortality rate for anemic patients was 16.4% vs. 8.8% in non-anemic patients (p<0.001). Anemia was an independent predictor of short-term mortality (OR=1.72, 95% CI=1.05-2.80, p=0.03), as was a NT-proBNP concentration >5180 pg/mL (OR=2.32, 95% CI=1.36-3.94 p=0.002). Consideration of four risk groups: not anemic/low NT-proBNP (reference group, n=220), anemic/low NT-proBNP (n=152), not anemic/high NT-proBNP (n=165), and anemic/high NT-proBNP (n=153) revealed respective 60-day mortality rates of 5.0% (referent), 9.2% (OR=1.93, 95% CI=0.85-4.36; p=0.12), 13.9% (OR=3.07, 95% CI=1.45-6.50, p=0.003), and 23.5% (OR=5.84, 95% CI=2.87-11.89, p<0.001)., Conclusions: Anemia was common in this cohort of subjects with acute HF and was related to adverse short-term outcome. Integrated use of hemoglobin and NT-proBNP measurements provides powerful additive information and is superior to the use of either in isolation.

Malignant hyperthermia (MH) is a pharmacogenetic disorder of skeletal muscle that presents as a hypermetabolic response to potent volatile anesthetic gases such as halothane, sevoflurane, desflurane and the depolarizing muscle relaxant succinylcholine, and rarely, in humans, to stresses such as vigorous exercise and heat. The incidence of MH reactions ranges from 1:5,000 to 1:50,000-100,000 anesthesias. However, the prevalence of the genetic abnormalities may be as great as one in 3,000 individuals. MH affects humans, certain pig breeds, dogs, horses, and probably other animals. The classic signs of MH include hyperthermia to marked degree, tachycardia, tachypnea, increased carbon dioxide production, increased oxygen consumption, acidosis, muscle rigidity, and rhabdomyolysis, all related to a hypermetabolic response. The syndrome is likely to be fatal if untreated. Early recognition of the signs of MH, specifically elevation of end-expired carbon dioxide, provides the clinical diagnostic clues. In humans the syndrome is inherited in autosomal dominant pattern, while in pigs in autosomal recessive. The pathophysiologic changes of MH are due to uncontrolled rise of myoplasmic calcium, which activates biochemical processes related to muscle activation. Due to ATP depletion, the muscle membrane integrity is compromised leading to hyperkalemia and rhabdomyolysis. In most cases, the syndrome is caused by a defect in the ryanodine receptor. Over 90 mutations have been identified in the RYR-1 gene located on chromosome 19q13.1, and at least 25 are causal for MH. Diagnostic testing relies on assessing the in vitro contracture response of biopsied muscle to halothane, caffeine, and other drugs. Elucidation of the genetic changes has led to the introduction, on a limited basis so far, of genetic testing for susceptibility to MH. As the sensitivity of genetic testing increases, molecular genetics will be used for identifying those at risk with greater frequency. Dantrolene sodium is a specific antagonist of the pathophysiologic changes of MH and should be available wherever general anesthesia is administered. Thanks to the dramatic progress in understanding the clinical manifestation and pathophysiology of the syndrome, the mortality from MH has dropped from over 80% thirty years ago to less than 5%.

Objectives: The objectives of this study were to examine the extent to which HIV-positive gay men in London intentionally seek unprotected anal intercourse ("barebacking") and the contribution this makes to total sexual risk., Study Design: In 2002 to 2003, HIV-positive gay men surveyed in an HIV outpatient clinic or on the Internet were asked whether they had intentionally looked for anal sex without a condom in the previous 12 months., Results: Of 481 men in the clinic, 59 (12.3%) said they had intentionally looked for anal sex without a condom, 34 (7.1%) only with another HIV-positive man and 25 (5.2%) with a man of unknown or discordant HIV status. Overall, 85 men reported unprotected anal intercourse (UAI) with a casual partner of unknown or discordant HIV status; 20 (23.5%) had intentionally looked for UAI with such a partner, whereas the remaining 65 (76.5%) had not. Of 66 men surveyed on the Internet, 32 (48.5%) said they had intentionally looked for anal sex without a condom., Conclusion: Although barebackers made a disproportionate contribution to sexual risk, three-fourths of high-risk sex reported by HIV-positive gay men in London was not intentional. The Internet sample overestimated the prevalence of barebacking among HIV-positive gay men because of sampling bias.

The decomposition of xylose has been studied using quantum mechanical calculations supported by NMR data. Proposed mechanisms for the decomposition of xylose have been investigated by obtaining the structures and energies of transition states and products. The intent of this study was to understand the experimentally observed formation of furfural and formic acid that occurs during the decomposition of xylose in mildly hot acidic solutions. A mechanism of furfural formation involving the opening of the pyranose ring and subsequent dehydration of the aldose was compared to a direct intramolecular rearrangement of the protonated pyranose. Energies were determined using CBS-QB3, and it was shown that the barriers for dehydration of the aldose were high compared to intramolecular rearrangement. This result suggests that the latter mechanism is a more likely mechanism for furfural formation. The intramolecular rearrangement step results from protonation of xylose at the O2 hydroxyl group. In addition, it has been shown that formic acid formation is a likely result of the protonation of xylose at the O3 hydroxyl group. Finally, solvation of xylose decomposition was studied by calculating energy barriers for xylose in selected water clusters. The mechanisms proposed here were supported in part by 13C-labeling studies using NMR.

Objective: To investigate the cause of the transient weakness that occurs in recessive myotonia congenita (RMC) following sustained muscle contraction., Methods: Nerve excitability studies were performed on a 35-year-old male with RMC due to a novel 696+1G>A CLCN1 mutation. The median nerve was stimulated at the wrist and compound muscle action potentials (CMAPs) were recorded from abductor pollicis brevis (APB). Stimulus-response behaviour using two stimulus durations, threshold electrotonus to 100-ms polarizing currents, a current threshold relationship and the recovery of excitability following supramaximal stimulation were recorded at rest. Excitability parameters were also recorded before and after maximal voluntary contraction (MVC) of APB against resistance for 60s. Results were compared to data obtained from 12 normal controls., Results: Baseline axonal excitability parameters were all normal, indicating that axonal function was normal at the point of stimulation. Following one minute of MVC, excitability parameters demonstrated a significant increase in threshold when compared to controls (RMC 54.9%; controls 15.5+/-3.1%). In the RMC patient, this increase in threshold was associated with a 39% reduction in the amplitude of the maximal CMAP, which remained unaffected in controls., Conclusions: The reduction in maximal CMAP is likely to represent muscle activation failure due to depolarization block, with the increase in threshold possibly reflecting a compensatory attempt by motor axons to overcome prolonged contraction-induced changes in the muscle membrane., Significance: The prolonged recovery of excitability following sustained muscle contraction is likely to be a contributing factor to symptoms of weakness and fatigue experienced by RMC patients.

Heterosexual women (n = 330), heterosexual men (n = 319) and gay men (n = 331) attending a London HIV-testing clinic in 2002-03 completed a confidential self-administered questionnaire concerning their sexual behaviour and use of the Internet for seeking sexual partners (response rate 70%). One-in-twenty (5%) heterosexual women and one-in-ten (10%) heterosexual men had used the Internet to look for sexual partners in the previous 12 months compared with nearly half (43%) the gay men (P<0.001). Rates of high-risk sexual behaviour with a casual partner were elevated among those who used the Internet to look for sex (compared with those who did not). However, people who looked for sex through the Internet were just as likely to meet their high-risk casual partners offline as online. Our findings suggest that high-risk heterosexual women and men are selectively using the Internet to look for sex rather than the Internet per se leading to riskier sexual behaviour.

Highly Active Anti-Retroviral Treatment (HAART) has reduced death and morbidity among people with HIV. However, HAART is not always effective, can produce serious side-effects and implies uncertainty for patients. To address HAART-related uncertainty, 20 qualitative interviews were conducted with gay men with HIV in Glasgow and London. The interviewees were purposively selected to reflect diversity in terms of year of diagnosis, experiences of illness and treatment-related side-effects. The interviews were analysed using the constant comparison method to derive themes. Among those using HAART, analysis identified themes of 'good health', 'illness' and 'loss of confidence'. Uncertainty was managed through a discourse of 'technological horizon' that combined the ongoing innovations of HAART and biographical time. These themes are discussed in terms of the implications for HIV care. In particular, technological horizon provides a basis for the management of uncertainty in the prescribing relationship between patient and clinician.

This paper addresses how London gay men use the internet to meet sexual partners, or for e-dating. Based on qualitative interviews conducted face-to-face or via the internet, this research develops an account of how information technologies mediate the negotiation of identity and risk in connection with sexual practice. E-dating itself is a bricolage, or heterogeneous DIY practice of internet-based-communication (IBC). A central aspect of IBC is "filtering" in and out prospective e-dates based on the images and texts used to depict sexual identities. Interpretations and depictions of personal HIV risk management approaches in IBC are framed by the meanings of different identities, such as the stigma associated with being HIV positive. This paper argues for a sexualities perspective in a theory of network society. Further, HIV prevention in e-dating can potentially be addressed by considering the interplay of the HIV prevention imperatives associated with different HIV serostatus identities. There is a case for encouraging more explicit IBC about risk in e-dating and incorporating the expertise of e-daters in prevention activity. There is also a need to rethink traditional conceptions of risk management in HIV prevention to make space for the risk management bricolage of network society.

Access to the Internet has increased dramatically over the past decade as has its use for meeting sexual partners (e-dating), particularly among gay men. Between June 2002 and January 2004, 128 gay/bisexual men living in London were interviewed one-to-one about their experience of e-dating, sexual risk and HIV prevention. The men were recruited both online (through the Internet) and offline (in clinics and the community); 32 men were HIV-positive, 59 HIV-negative, while 13 had never had an HIV test. A key finding was that both identity as well as anonymity are vital to e-dating. Through a process of online filtering and sero-sorting, HIV-positive men are able to meet other positive men for anal sex without condoms. While this does not present a risk of HIV transmission to an uninfected person it does have implications for the potential transmission of other STIs such as syphilis and LGV. Through e-dating, HIV-positive gay men can also avoid abuse, discrimination and sexual rejection. Our findings do not support the suggestion that the attraction of e-dating is that it affords absolute anonymity. We found that the gradual expression of identity is vital for e-dating among gay men. Internet-based HIV prevention campaigns need to take account of the different ways in which gay reflexively manage aspects of their identity online.

Objective: Few of the increasing number of pediatric clinical trials of selective serotonin reuptake inhibitors (SSRIs) in children have been evaluated for level of blindness of investigators, children, and parents. The success of the masking procedures used in a double-blind, pediatric trial of fluvoxamine in children was examined., Method: Clinical evaluators, parents, and children were asked to guess individual treatment assignment at the end of an 8-week, placebo-controlled trial of fluvoxamine conducted in 128 outpatients (6-17 years of age) with anxiety disorders. The relationship between treatment attribution and improvement status or presence of adverse events was examined., Results: The rate of correct guesses was significantly greater than chance among clinical evaluators (78%), parents (81%), and children (67%) (for all, p < 0.001). Attribution to fluvoxamine was associated with presence of clinical improvement, and attribution to placebo with lack of improvement (p < 0.001) in both the fluvoxamine and placebo group. There was no association between presence of adverse events and direction of the guess. Accuracy of the guess did not improve with time., Conclusions: The tendency to attribute improvement to active treatment and lack of improvement to placebo was consistent across investigators, parents, and children and was applied regardless of actual treatment received by the patient. Adverse events did not influence treatment attribution.

Veneous ulcers are extremely common, accounting for a large proportin of all lower extremity ulcers. Due to their chronicity and relatively high prevalence, their impact on the cost of healthcare and the lives of the patients affected is quite significant. There has been progress in understanding the pathophysiology, clinical features, and diagnosis of these ulcers, but the basic principles of care have remained consistent for almost a half century. To allow for optimal healing, it is important to maintain a clean moist wound bed, treat any clinically significant infection, and decrease surrounding edema.

Ab initio molecular dynamics simulations were employed to investigate, with explicit solvent water molecules, beta-D-glucose and beta-D-xylose degradation mechanisms in acidic media. The rate-limiting step in sugar degradation was found to be protonation of the hydroxyl groups on the sugar ring. We found that the structure of water molecules plays a significant role in the acidic sugar degradation pathways. Firstly, a water molecule competes with the hydroxyl group on the sugar ring for protons. Secondly, water forms hydrogen bonds with the hydroxyl groups on the sugar rings, thus weakening the C-C and C-O bonds (each to a different degree). Note that the reaction pathways could be altered due to the change of relative stability of the C-C and C-O bonds. Thirdly, water molecules that are hydrogen-bonded to sugar hydroxyls could easily extract a proton from the reaction intermediate, terminating the reaction. Indeed, the sugar degradation pathway is complex due to multiple protonation probabilities and the surrounding water structure. Our experimental data support multiple sugar acidic degradation pathways.

Objective: To examine whether the excess risk for HIV and sexually transmitted infection (STI) seen among gay men who look for sex through the Internet occurs with men they meet online (through the Internet) rather than offline (in bars, clubs, etc)., Methods: In 2002-2003, 4225 London gay men were surveyed in an HIV treatment clinic, HIV testing clinic, gyms and on UK Internet sites (gaydar and gay.com). All men completed a self-administered questionnaire concerning Internet use and sexual risk behaviour. Unprotected anal intercourse (UAI) with a partner of unknown or discordant HIV status was classified as non-concordant., Results: Between 40 and 50% of men surveyed in the clinics and gyms used the Internet to look for sex. HIV-positive men who looked for sex through the Internet were more likely to report UAI with HIV-positive casual partners they met online rather than offline (clinic sample: met online only 9.9%, met offline only 3.8%, McNemar P < 0.05). Regardless of HIV status, however, men who looked for sex through the Internet were no more likely to report UAI with non-concordant casual partners they met online than offline (eg, HIV-negative men, Internet sample: met online only 9.7%, offline only 11.1%, McNemar P = 0.6)., Conclusions: In London, HIV-positive gay men appear to meet casual UAI partners of the same status through the Internet. This presents a risk for STI transmission. However, gay men were no more likely to meet casual UAI partners of unknown or discordant HIV status--which presents a risk for HIV transmission--online rather than offline.

Rett syndrome is a severe neurodevelopmental disorder affecting girls, caused by mutations in the MECP2 gene. There are no population-based data on the extent and determinants of health service use in this disorder. The population-based registry, the Australian Rett Syndrome database, was the source of phenotype data. This also contains data from mutation screening and X-inactivation studies. Data on retrospective (n = 152) and prospective (n = 162) health service use were collected in 2000 from a questionnaire and a calendar study, respectively. Health service use was highest in younger cases (P = .001) and lowest in cases with milder phenotypes (P < .001). Random X-inactivation was associated with service use (P = .02). Maternal education, phenotype, and individual mutations were determinants of health service use. The use of a retrospective and prospective data set enabled accurate assessment of service use in Rett syndrome. Both genetic and sociodemographic determinants of health service use were identified, with important implications for the optimal and equitable management of children with Rett syndrome.

Respiratory emergencies will continue to make up a large percentage of our EMS calls. Many of these conditions will be managed in the same fashion early on with a focus on oxygenation and adequate ventilation. Once the ABCs have been stabilized, use your assessment skills to create a differential diagnosis for respiratory distress. Once a field impression has been made, you can better direct a specific treatment. As always, follow your local treatment protocols established by your medical director. Practice your assessment skills and attend as much training as you can on airway and respiratory emergencies.

There is little published research about how people who inject drugs are responding to the hepatitis C epidemic. This study seeks to address the prevention of hepatitis C using qualitative interviews with people who inject drugs in London. We explored narratives about risk reduction and hepatitis C in the social and historical context of other risks such as HIV, vein damage and overdose. Themes of the narratives included: the importance of autonomy in the acquisition of safer injecting skills; that safer injection was regarded as 'common sense', normalised and predicated on the risk of HIV; that hepatitis C risk was relativised with HIV risk and thereby seen as less important; and that hepatitis C infection was also seen as unavoidable. These narrative forms represent significant challenges for the management of the hepatitis C epidemic, both in terms of the existing risk reduction efforts designed for HIV and in terms of the articulation of risk reduction for injectors with general public health policy.